How IBM Watson is helping doctors diagnose & treat cancer in India

IBM Watson, a powerful computing platform, can ingest millions of pages of research papers and patient records in a jiffy .Its artificial intelligence (AI) technology can pull together connected strands of information to make better sense of them.Shilpa Phadnis&Sujit John | TNN | Updated: August 24, 2016, 14:13 IST

BENGALURU: Dr Somashekhar SP , oncologist and chairman of Manipal Hospitals' comprehensive cancer centre, sees 120 patients and does multiple surgeries every day. He says he cannot keep pace with the 130 or so new research papers on oncology published daily.

But IBM's Watson can. Watson, a powerful computing platform, can ingest millions of pages of research papers and patient records in a jiffy .Its artificial intelligence (AI) technology can pull together connected strands of information to make better sense of them. It learns as it goes, including from its mistakes. And over the past few years, it has been trained by New York's Memorial Sloan Kettering Cancer Centre, one of the world's best cancer treatment and research institutions. So, Watson today can do better than a doctor in diagnosing cancer and figuring the best treatment option for a patient.

A few days ago, leading oncologists and doctors of Manipal Hospitals ­ owned by billionaire Ranjan Pai ­ came close to paying obeisance to God Watson, in front of select media. Showcasing the technology, Dr Ajay Bakshi, CEO of Manipal Hospitals, described Watson as humble and intelligent. “It has no ego, no biases,“ he said.

Dr Somashekhar noted that every seven days a new oncology drug comes up, and by the time he hears about it, it could be years. “Doctors also have different opinions on what treatment protocol to follow for a patient, based on different experiences. In Manipal, we normally sit together to decide. Now, we have another important member (Watson). It not only gives the right treatment option, it also provides evidence for why option A will work better than option B,“ he said.

Late last year, Manipal entered into an agreement with IBM to use Watson for oncology, the first hospital chain in India to do so. Following cus tomisations and tests, the hospital recently started offering the service to patients. The Watson report comes at no additional cost.

Oncologist Dr Amit Rauthan demonstrated how Watson works. He had prefilled the details of a patient on the system. He clicked a submit button, and within about two minutes, Watson showed its recommendations. The top re c o m m e n d e d treatment was highlighted in green ­ an oral drug. Then came one in amber.And then a whole lot in red, the ones that are best avoided. Dr Rauthan said they were surprised by Watson's choice. “We doctors tend to recommend chemotherapy right away . But here Watson was suggesting an oral drug,“ he said.

Cancer is enormously complicated. Breast cancer, for instance, has some 64 treatment protocols, and which protocol to follow depends on a range of factors about the patient. Dr Rauthan and oncologist Dr Poonam Patil told TOI that these include fitness level, age, the state of body functions, genetic profile, the stage of cancer, and the type of cancer. The cancer cells can be estrogen-receptor-positive (ER+) or progesterone-receptor-positive (PR+) or it can have large amounts of HER2 protein that makes the cells grow aggressively .

In Manipal, a team of oncology experts sit together with all these details about a patient to decide what protocol to follow. The team often takes a day or more to arrive at a decision.Even then, it will be based on the experience of the members, which by their own admission, is limited. Watson, on the other hand, has years of intelligence and experience from around the world within it.

In 2013, Samuel Nussbaum, who was then chief medical officer of US health insurance firm WellPoint (now Anthem), said in an article in Wired that in tests, Watson's successful diagnosis rate for lung cancer was 90%, compared to 50% for human doctors.

Besides recommending the best treatment protocols, Watson also provides proof of why it's making those recommendations. It tells patients their chances of survival with different treatments, and the side effects of each.

Cancer is a particularly big problem in India, where there are 4 million patients and one oncologist for 1,600 patients, compared to one oncologist for 100 patients in the US. “Watson looks to have been made for India, given its expertise and the scale at which it can operate,“ IBM India MD Vanitha Narayanan said. For patients who cannot come to Manipal Hospitals, Manipal is offering an online platform onto which patients can upload all details, and Manipal will send a Watson report for a fee. But IBM Watson's vice president for oncology and genomics Rob Merkel said the company is in discussions with many more hospitals in India for adoption of Watson. For India, Watson is also being tweaked to provide cost estimates for different treatment protocols to simplify patient decisions.

Asked if Watson in time would make doctors irrelevant, Dr Somashekhar said doctors bring a human element that is important to patients. Talking about this issue in an article in Wired in 2014, Alan Greene, who was then chief medical officer of Scanadu, a startup building an AI-powered diagnostic device, said: “At the rate AI technology is improving, kids born today will rarely need to see a doctor to get a diagnosis by the time they are adults.“